International heart journal最新文献

It remains unclear whether elevated ventricular wall pressure and left ventricular enlargement in patients with left ventricular systolic dysfunction (LVSD) can lead to left bundle branch block (LBBB). In this study, 801 consecutive hospitalized patients with a left ventricular ejection fraction of < 50% were enrolled. The primary outcome was the occurrence of new-onset LBBB or heart failure-related hospitalization, all-cause mortality, ventricular tachycardia, or implantation of an implantable cardioverter-defibrillator (ICD) /cardiac resynchronization therapy (CRT). During a median follow-up of 56 months, 70 cases of new-onset LBBB were observed, with a cumulative incidence rate of 10.1%. Multivariate Cox regression analysis demonstrated that paroxysmal atrial fibrillation (PAF) (hazard ratio [HR] 2.907, 95% confidence interval [CI] 1.552-5.444, P = 0.001), coronary artery disease (CAD) (HR 6.680, 95% CI 3.451-12.930, P < 0.001), dilated cardiomyopathy (DCM) (HR 6.394, 95% CI 3.501-11.675, P < 0.001), QRS duration (HR 1.018, 95% CI 1.010-1.027, P < 0.001), left ventricular end-diastolic dimension (LVEDD) (HR 1.032, 95% CI 1.006-1.059, P = 0.016), and β-blockers (HR 0.327, 95% CI 0.199-0.536, P < 0.001) were independent predictors of new-onset LBBB. A Kaplan-Meier survival curve analysis demonstrated that patients with new-onset LBBB had a higher incidence of composite endpoint events (P < 0.001), heart failure-related hospitalization (P < 0.001), and ventricular tachycardia or implantation of an ICD or CRT (P < 0.001) than patients without new-onset LBBB. Moreover, new-onset LBBB (HR 1.603, 95% CI 1.207-2.129, P = 0.001) was an independent predictor of composite endpoint events.DCM, LVEDD, CAD, PAF, and QRS duration were independent predictive factors for the subsequent development of LBBB in patients with LVSD. New-onset LBBB was independently associated with a poor prognosis.

The postprocedural outcomes of coronary chronic total occlusion (CTO) revascularization in patients with left ventricular systolic dysfunction (LVSD) are still unclear. In this study, the periprocedural safety of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for revascularization of CTO in patients with LVSD is evaluated.In this study, patients hospitalized for coronary heart disease complicated by LVSD who underwent CTO PCI or CTO CABG between 2014 and 2020 were involved. The primary endpoint was 30-day major adverse cardiac or cerebrovascular events (MACCE), defined as the composite of all-cause mortality, cardiovascular mortality, stroke, myocardial infarction (MI), and target vessel revascularization. To evaluate the influence of the CTO revascularization strategies on 30-day outcomes, inverse probability of treatment weighting (IPTW) based on the propensity score was employed, and to identify predictors of 30-day MACCE, Cox regression was utilized.Among the 658 patients who satisfied the criteria, 440 (66.87%) underwent CTO PCI, and 218 (33.13%) underwent CTO CABG. The primary endpoint occurred in 30 (4.56%) patients, which is mainly attributed to all-cause mortality. Following IPTW adjustment, CTO CABG was found to be associated with significantly elevated risks of 30-day MACCE and MI (all P < 0.05).In this study in which patients with CTO and LVSD were examined, an increased risk of 30-day MACCE was observed in those who underwent CTO CABG. For such complex and high-risk patients, CTO PCI may represent a revascularization strategy that offers superior postprocedural safety.

To date, only a few studies have assessed the dietary preferences, lifestyle habits, and risk factors of patients with acute myocardial infarction. This study aimed to investigate the dietary preferences and lifestyle habits of these patients to reflect on the implementation of an effective comprehensive diet therapy in the future.In total, 117 patients who were admitted to Fukuoka University Nishijin Hospital due to acute myocardial infarction from April 2014 to January 2020 were enrolled. Test values, dietary preferences, and lifestyle habits as well as specificity were investigated in patients aged < 70 years (n = 62) and ≥ 70 years (n = 55).Of the patients < 70 years of age, 56.5% preferred high-fat foods and 29.0% preferred high-salt foods, whereas of the patients ≥ 70 years of age, 41.8% preferred high-sugar foods and 32.7% preferred high-salt foods (P < 0.01). The percentages of patients who tended to eat out and drink were 60.7% and 34.2%, respectively. The percentage of patients with a smoking habit was 31.6%.Since improved lipid levels are an important target in nutritional guidance, we should consider adjusting the diet and guiding patients to stop drinking and smoking among young people and reducing sugar and salt intake in the elderly.

This study aimed to evaluate the impact of obesity on in-hospital outcomes of patients with HF undergoing AF catheter ablation. This population-based, retrospective observational study extracted data from the US Nationwide Inpatient Sample (NIS) database 2005-2018. Patients ≥ 20 years with HF and undergoing catheter ablation for AF were eligible for inclusion. Propensity-score matching (PSM) was utilized to balance the baseline characteristics between obese and non-obese groups. Univariate and multivariable regression analyses were used to determine the associations between obese status and other variables with the in-hospital outcomes. These outcomes included non-home discharge, prolonged length of stay (LOS), complications, and a composite outcome that encompassed these outcomes along with in-hospital mortality. A total of 18,751 patients were included. After PSM, 8,014 patients remained in the study sample. The mean age was 64.6 ± 0.1 years. After adjustment, significant association was detected between obesity and greater odds of non-home discharge (adjusted odd ratio [aOR] = 1.18), prolonged LOS (aOR = 1.18), complications (aOR = 1.30), respiratory failure/mechanical ventilation (aOR = 1.56) and acute kidney injury (AKI) (aOR = 1.28), central nervous system and peripheral neuropathy (aOR = 1.33), and transient ischemic attack (aOR = 8.16), as well as poor composite outcome (aOR = 1.28) compared with non-obese patients. In US patients with HF undergoing AF catheter ablation, obesity is associated with a higher risk for non-home discharge, prolonged LOS, and several major complications. Clinicians should exercise heightened vigilance when administering therapy to this subgroup of patients.

Isolated cardiac sarcoidosis (iCS) is increasingly recognized; however, its prognosis and the efficacy of immunosuppressive therapy remain undetermined. We aimed to compare the prognosis of iCS and systemic sarcoidosis including cardiac involvement (sCS) under immunosuppressive therapy.

We retrospectively reviewed the clinical data of 42 patients with sCS and 30 patients with iCS diagnosed at Kyushu University Hospital from 2004 through 2022. We compared the characteristics and the rate of adverse cardiac events including cardiac death, fatal ventricular tachyarrhythmia, and heart failure hospitalization between the 2 groups. The median follow-up time was 1535 [interquartile range, 630-2555] days, without a significant difference between the groups. There were no significant differences in gender, NYHA class, or left ventricular ejection fraction. Immunosuppressive agents were administered in 86% of sCS and in 73% of iCS patients (P = 0.191). When analyzed only with patients receiving immunosuppressive therapy (sCS, n = 36; iCS, n = 21), the cardiac event-free survival was significantly lower in iCS than sCS (37% versus 79%, P = 0.002). Myocardial LGE content at the initial diagnosis was comparable in both groups. The disease activity was serially evaluated in 26 sCS and 16 iCS patients by quantitative measures of FDG-PET including cardiac metabolic volume and total lesion glycolysis, representing 3-dimensional distribution and intensity of inflammation in the entire heart. Although iCS patients had lower baseline disease activity than sCS patients, immunosuppressive therapy did not attenuate disease activity in iCS in contrast to sCS.

iCS showed a poorer response to immunosuppressive therapy and a worse cardiac prognosis compared to sCS despite lower baseline disease activity.

Tracheobronchial or esophageal fistula after aortic surgery has been reported sporadically in the literature, however, reports of an aortopulmonary fistula associated with a post-operative aortic pseudoaneurysm are rare. We experienced a case of refractory heart failure due to an aortopulmonary fistula associated with a post-operative aortic pseudoaneurysm. A 60-year-old man who had undergone aortic surgery 2 years earlier was hospitalized for congestive heart failure. He was diagnosed with refractory heart failure after 10 days of diuretic therapy failed to improve his condition. He underwent a contrast-enhanced computed tomography (CT) scan and was suspected to have pulmonary artery perforation of an aortic pseudoaneurysm at the anastomotic site of the ascending aortic surgery. Transesophageal echocardiography showed shunt blood flow from the aortic aneurysm into the right pulmonary artery, leading to a definitive diagnosis of aortopulmonary fistula with post-operative aortic pseudoaneurysm. Computed tomography angiography is commonly used to diagnose an aortic fistula; however, diagnosis is often difficult because of the subtle imaging findings. We highlight the usefulness of transesophageal echocardiography in providing a definitive diagnosis and detailed morphologic information on this pathophysiology.

Cardiac rupture is a fatal complication following myocardial infarction (MI) and there are currently no effective pharmacological strategies for preventing this condition. In this study, we investigated the effect of colchicine on post-infarct cardiac rupture in mice and its underlying mechanisms.

We induced MI in mice by permanently ligating the left anterior descending artery. Oral colchicine or vehicle was administered at a dose of 0.1 mg/kg/day from day 1 to day 7 after MI. Cultured neonatal cardiomyocytes and fibroblasts were exposed to normoxia or anoxia and treated with colchicine.

Colchicine significantly improved the survival rate (colchicine, n = 46: 82.6% versus vehicle, n = 42: 61.9%, P < 0.05) at 1 week after MI. Histological analysis revealed colchicine significantly reduced the infarct size and the number of macrophages around the infarct area. Colchicine decreased apoptosis in the myocardium of the border zone and cultured cardiomyocytes and fibroblasts as assessed by TUNEL assay. Colchicine also attenuated the activation of p53 and decreased the expression of cleaved-caspase 3 and bax, as assessed by Western blotting.

Colchicine prevents cardiac rupture via inhibition of apoptosis, which is attributable to the downregulation of p53 activity. Our findings suggest that colchicine may be a prospective preventive medicine for cardiac rupture, however, large clinical trials are required.

Excessive neointimal hyperplasia (NIH) of coronary vessels in patients is the main cause of restenosis (RS) after percutaneous coronary intervention (PCI). This study aimed to identify the regulatory genes related to NIH in a rat carotid artery balloon injury model.

We established a rat model and performed RNA sequencing to identify differentially expressed long non-coding RNAs (DElncRNAs) and differentially expressed message RNAs (DEmRNAs). Immune cells were analyzed using a murine Microenvironment Cell Population counter. The Pearson correlation between DEmRNAs, DElncRNAs, and immune cells was analyzed, followed by function enrichment analysis. Core DEmRNA was identified using Cytoscape. Next, a core lncRNAs-mRNAs-immune cell regulatory network was constructed. NIH-related gene sets from the Gene Expression Omnibus and GeneCards databases were used for validation.

A total of 2,165 DEmRNAs and 705 DElncRNAs were identified in rat carotid artery tissue. Four key immune cells were screened out, including mast cells, vessels, endothelial cells, and fibroblasts. Based on the Pearson correlation between DEmRNAs, DElncRNAs and 4 key immune cells, 246 DEmRNAs and 93 DElncRNAs were obtained. DEmRNAs that interact with lncRNAs were mainly involved in the cell cycle, MAPK signaling pathway, and PI3K-Akt signaling pathway. A core lncRNA-mRNA-immune cell regulatory network was constructed, including 9 mRNAs, 4 lncRNAs, and fibroblasts. External datasets validation confirmed the significant correlation of both these mRNAs and lncRNAs with NIH.

In this study, an lncRNA-mRNA-immune cell regulatory network related to NIH was constructed, which provided clues for exploring the potential mechanism of RS in cardiovascular diseases.

Many studies have reported a relationship between various lipids, such as cholesterol, fatty acids, and lipoproteins, and cardiovascular events. Low-density lipoprotein cholesterol (LDL-C) is often cited as a representative marker. However, there is still room for discussion regarding which markers, among other lipids, should take clinical precedence.

This observational study focused on patients without residual stenosis on post-coronary angiography. It was based on blood tests, including lipid profiles at that time, and assessed the association with the subsequent occurrence of major adverse cardiovascular events (MACE, a composite of all-cause mortality, hospitalization due to heart failure, myocardial infarction, stroke, and all revascularizations).

Of the 375 patients analyzed, 134 experienced MACE (median follow-up duration: 1031 days). When comparing the MACE and non-MACE groups, significant differences were observed in lipid markers such as non-high-density lipoprotein cholesterol (non-HDL-C) and remnant-like particle cholesterol (RLP-C) (non-HDL-C; P = 0.003, RLP-C; P < 0.001). Furthermore, the area under the curve for RLP-C was 0.656 (95% CI: 0.598-0.714). Improvement in MACE risk discrimination was observed when LDL-C was replaced with non-HDL-C or RLP-C, in addition to atherosclerosis risk factors (non-HDL-C; net reclassification improvement (NRI) = 0.366, 95% CI: 0.159-0.572, RLP-C; NRI = 0.224, 95% CI: 0.016-0.433).

It is highly likely that non-HDL-C and RLP-C can serve as significant lipid markers for predicting the occurrence of MACE.

Left atrial appendage (LAA) closure can prevent stroke in high-risk patients with atrial fibrillation.

A bioabsorbable LAA occluder made of degradable polymer materials, such as polydioxanone (PDO) and poly-L-lactic acid (PLA), and nitinol wire was used. Occluders were successfully implanted in 18 Chinese rural dogs, 2 of which died within 48 hours after operation due to pericardial tamponade and hemorrhage, respectively. Follow-up observation was performed after transcatheter LAA closure. New tissue was found on the surface of the occluder 2 months after operation. No adjacent structures such as the mitral valve and the left superior pulmonary vein were affected by the occluder discs. Hematoxylin and eosin (HE) staining was performed at 3 months after operation, which showed intact intimal structure on the occluder surface, and unabsorbed PDO and PLA were observed. Scanning electron microscopy showed irregular arrangement of endothelial cells. New endothelial tissue was observed to completely cover the occluder at 6 months after operation. Most PDOs were replaced by fibrous connective tissue, and scanning electron microscopy showed regularly arranged endothelial cells. Pathological examination at 12 months showed only a small remnant of PDO. The gross specimens of the liver, spleen, and kidneys and pathological examination did not indicate thromboembolism.

The bioabsorbable LAA occluder made of PDO, PLA, and nitinol wire was safe and effective for the occlusion of LAA in dogs. The surface of the occluder was endothelialized half a year after operation. The absorbable materials of the occluder were degraded after 1 year.